评估基于证据的孕产妇败血症早期诊断的患者层面风险因素。
Assessing patient-level risk factors for evidence-based early diagnosis of maternal sepsis.
作者信息
Anyanwu Philip Emeka, Expert Paul, Honeyford Kate, Bello Oluwasomidoyin, Salawu Mobolaji Modinat, Adeoye Ikeola, Adebowale Ayo Stephen, Nwosu Amen-Patrick, Zaher Summia, Ghazal Peter, Fagbamigbe Adeniyi Francis, Dairo Magbagbeola David, Costelloe Ceire
机构信息
Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK.
Global Digital Health Unit, School of Public Health, Imperial College London, London, UK.
出版信息
BMC Pregnancy Childbirth. 2025 Jul 22;25(1):782. doi: 10.1186/s12884-025-07895-4.
BACKGROUND
Maternal sepsis is a leading cause of maternal death, with the burden higher in low- and middle-income countries (LMICs). Early Warning Systems (EWS) combine clinical observations to identify a pattern consistent with an increased risk of clinical deterioration and have been introduced for monitoring sepsis risk. Maternal sepsis risks in LMICs are driven by factors at the health system and patient levels. This study assessed patient-level risk factors -age, health-seeking behaviour, comorbidities and procedures- associated with maternal sepsis in an urban tertiary hospital in Nigeria.
METHODS
We conducted a retrospective study using health records of 4,510 patients from obstetrics and gynaecology units at a tertiary hospital in southwestern Nigeria from 2016 to 2020. To examine the association between patient-level risk factors and sepsis, we analysed data for the 565 maternal patients with a record of infection using a multiple logistic regression model. We extended the model by introducing interaction terms to assess whether the association between the risk factors and maternal sepsis varied by socio-demographic factors.
RESULTS
About one-fifth of the 565 maternal patients with an infection had sepsis. Patients with sepsis had the lowest rate of live birth (29.7%) compared to those with (41.8%) and without (82.1%) an infection. Proportions of stillbirth (intrauterine fetal death) and early neonatal deaths were highest among patients with sepsis (15.3% and 1.8%) compared to those with (13.2% and 2.1%) and without (4.5% and 1.7%) an infection. Antenatal care booking status (OR: 0.17; 95% CI: 0.08-0.38) and having a catheter (OR: 2.60; 95% CI: 1.35-5.01) were significantly associated with maternal sepsis in the adjusted model.
CONCLUSION
Our results suggest that improving access to antenatal care services for pregnant women will substantially reduce the risk of maternal sepsis in the Nigerian population. Guidelines for maternal sepsis management should consider subgroups of patients at higher risk, such as those with urethral catheters.
背景
孕产妇败血症是孕产妇死亡的主要原因，在低收入和中等收入国家（LMICs）负担更重。早期预警系统（EWS）结合临床观察来识别与临床病情恶化风险增加相一致的模式，并已被引入用于监测败血症风险。低收入和中等收入国家的孕产妇败血症风险受卫生系统和患者层面因素的驱动。本研究评估了尼日利亚一家城市三级医院中与孕产妇败血症相关的患者层面风险因素——年龄、就医行为、合并症和医疗程序。
方法
我们使用了尼日利亚西南部一家三级医院2016年至2020年妇产科4510名患者的健康记录进行回顾性研究。为了检验患者层面风险因素与败血症之间的关联，我们使用多元逻辑回归模型分析了565名有感染记录的孕产妇患者的数据。我们通过引入交互项来扩展模型，以评估风险因素与孕产妇败血症之间的关联是否因社会人口学因素而异。
结果
565名有感染的孕产妇患者中约五分之一患有败血症。与有感染（41.8%）和无感染（82.1%）的患者相比，患有败血症的患者活产率最低（29.7%）。与有感染（13.2%和2.1%）和无感染（4.5%和1.7%）的患者相比，败血症患者的死产（宫内胎儿死亡）和早期新生儿死亡比例最高（15.3%和1.8%）。在调整后的模型中，产前护理登记状态（比值比：0.17；95%置信区间：0.08 - 0.38）和留置导尿管（比值比：2.60；95%置信区间：1.35 - 5.01）与孕产妇败血症显著相关。
结论
我们的结果表明，改善孕妇获得产前护理服务的机会将大幅降低尼日利亚人群中孕产妇败血症的风险。孕产妇败血症管理指南应考虑高风险患者亚组，如留置导尿管的患者。
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